Alcohol and Other Drug Use

AODA Evaluation and Treatment Services

Counseling Services, located in the Northwest Quadrant, provides personal counseling, including confidential alcohol and other drug assessment, brief counseling, crisis counseling and referral assistance. Call 414-229-7429 to schedule an appointment, and for more information, visit https://uwm.edu/wellness/counseling/.

Additional On-Campus Programs and Related Links

UWM’s Brief Alcohol & Other Drug Screening & Intervention Programs (BASICS)
UWM’s Brief Alcohol & Other Drug Screening & Intervention Programs offer students the opportunity to examine their use of and experiences with alcohol and/or other drugs in a non-judgmental and confidential setting. Offered by the Student Health and Wellness Center Office of Health Promotion & Wellness, the goal is to help students make substance use decisions that result in fewer negative consequences. Find more information on BASICS I and BASICS II at https://uwm.edu/basics/

eCheck Up to Go
This anonymous online alcohol assessment provides users with personalized feedback regarding their individual drinking patterns, experiences, and risk factors. Visit www.e-CHUG.uwm.edu

Attention Deficit Hyperactivity Disorder (ADHD)

Attention-Deficit Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with functioning in multiple settings. Symptoms generally present in childhood and cause impairment in social, academic, and/or occupational functioning. Some students enter college with a history of ADHD and it is important to continue treatment, including ongoing medication management and counseling, when appropriate. Many students experience difficulty adjusting to college life and report periods of decreased concentration, attention, restlessness and distractibility. For most, these symptoms do not indicate ADHD and will resolve over time without intervention. If they persist, it may be necessary to schedule an evaluation to determine the underlying causes of the impairment. An evaluation may involve a diagnostic interview, including academic, personal and family history. In many cases, it may also be necessary to obtain psychological testing to confirm the diagnosis of ADHD as the symptoms of other disorders (anxiety, depression, trauma, and alcohol and drug abuse) are often confused with ADHD.

The Student Health and Wellness Center policy requires that all students seeking treatment for ADHD with one of our psychiatry providers must first have a comprehensive evaluation on file to ensure accurate diagnosis and appropriate treatment.

Anxiety

At some point, most college students report that they feel stressed. New environments, relationships, financial responsibilities, studying for exams, or class presentations can leave you feeling anxious. In certain situations, time and self-care (adequate rest, balanced diet, exercise), may resolve these feelings. Other students may feel a heightened degree of anxiety that includes intense worry or panic, physical discomfort, and an inability to calm themselves or relax. According to the National Institute of Mental Health, 1 in 9 people in the U.S. suffer from an anxiety disorder at any given time. The good news is that there are effective treatment options for anxiety disorders and for many, the symptoms resolve or become more manageable.

Examples of anxiety disorders include:

Panic Disorder
A discrete period of intense fear or discomfort with symptoms that could include: palpitations (racing heart, pounding), sweating, shortness of breath or chest discomfort, dizziness, fear of dying or losing control, and abdominal distress. At times the symptoms appear to be unrelated to specific stressors and often dissipate in a short period of time.

Generalized Anxiety Disorder (GAD)
Excessive apprehension and worry about a number of events or activities (such as work, school performance, health) that the individual finds difficult to control and persists on more days than not for at least six months. Symptoms associated with GAD may be restlessness or feeling “keyed up”, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbance.

Obsessive Compulsive Disorder (OCD)
Persistent unwanted thoughts, images, beliefs or compulsive behaviors that are distressing and interfere with activities of daily life. Common examples of obsessive thoughts are fears related to locking doors, leaving appliances on or unrealistic contamination from germs. Many people with OCD develop compulsive behaviors characterized by the overwhelming need to perform a ritual in order to prevent or reduce the resulting anxiety associated with the obsessive fear. Common compulsions are excessive hand washing, checking behaviors, counting rituals, ordering and hoarding. Persistent unwanted thoughts, images, beliefs or compulsive behaviors that are distressing and interfere with activities of daily life. Common examples of obsessive thoughts are fears related to locking doors, leaving appliances on or unrealistic contamination from germs. Many people with OCD develop compulsive behaviors characterized by the overwhelming need to perform a ritual in order to prevent or reduce the resulting anxiety associated with the obsessive fear. Common compulsions are excessive hand washing, checking behaviors, counting rituals, ordering and hoarding.

Post Traumatic Stress Disorder (PTSD)
Persistent symptoms occurring after witnessing or experiencing a traumatic event. Common examples are physical or sexual violence, accidents or war experiences. Symptoms can include: recurrent, intrusive and distressing recollections of the event, including thoughts, images or perceptions; recurrent dreams of the event or difficulty sleeping; acting or feeling that the event is recurring; avoiding people or situations that serve as a reminder; being easily startled and feeling numb and detached. Symptoms must persist for at least 1 month following the event and cause significant distress in one’s life.

Depression / Mood Disorders

Living away from home for the first time, financial worries, academic pressures and relationship concerns can all lead someone to feel down and can affect your self-esteem and functioning. According to the National Institute of Mental Health, approximately 19 million Americans are affected by depressive disorders.

Symptoms of Depressive Episodes

• Depressed mood for more than 2 weeks
• Insomnia or sleeping much more than usual
• Changes in appetite, eating more or less than usual
• Decreased energy and motivation
• Decreased interest in usual activities
• Poor concentration
• Feelings of hopelessness
• Decreased sexual interest
• Guilt
• Isolation
• Thoughts of suicide

Causes
Most research points to heredity, environment and brain chemistry changes contributing to the development of depression. At times there may not appear to be a specific trigger for symptoms. Depression is not about being lazy, weak or lacking willpower.

Treatment
When you recognize the symptoms of depression, or your functioning becomes impaired, it may be time to seek professional help. Meeting with an individual therapist, primary care doctor or psychiatrist can be a good place to start. Sometimes medications can be helpful to alleviate the symptoms that are affecting your ability to navigate the activities of daily life. There are also things you can do that may affect your mood. Staying active, exercising, avoiding drugs and alcohol, regular sleep and supportive relationships, all have a positive impact on symptoms of depression. Be patient with yourself. Getting better takes time.

Bipolar Disorder

Bipolar disorder, formally known as manic-depressive illness, is characterized by dramatic shifts of mood from extreme “highs” to episodes of deep depression. The mood changes go beyond the usual ups and downs that most people experience throughout the course of life. Approximately 1% of the population is thought to be affected by bipolar disorder. Men and women are affected equally. A majority of those affected begin to experience symptoms before age 25 so it is key that college students be aware of bipolar disorder.

Symptoms of Bipolar Disorder:

Depressive Episodes

• See above

Manic Episodes

• Racing thoughts
• Decreased need for sleep
• Increased energy/restlessness/ irritability
• Rapid speech, pressure to keep talking
• Euphoria
• Grandiose beliefs about self
• Reckless or impulsive behavior
• Poor judgment
• Substance abuse
• Paranoia or delusional beliefs
• Suicidal ideation

Causes
Most scientists agree that there is not one specific cause for bipolar disorder but rather a combination of genetic vulnerability, neurotransmitter imbalance and stressful life events. It is thought that if an individual is genetically predisposed to developing the disorder then stressful events may act as a catalyst for the development of symptoms.

Treatment
A thorough evaluation is vital to effective treatment of bipolar disorder. Because the individual can have varying degrees of manic, depressive, or mixed (combination of manic and depressive symptoms concurrently) symptoms it is necessary to identify appropriate medication to target the individual’s specific symptoms. Individuals are routinely treated with mood stabilizers, antidepressants, and newer atypical antipsychotic medications. Because of the impact on functioning and relationships, it is also beneficial to have psychotherapy focused on recognizing the onset of increased symptoms, stress management, and coping with the impact on relationships and daily life. Supportive family, friends, school, and work environments can be an important component of the most effective treatment outcomes.

Domestic Violence / Relationship Abuse

According to a Bureau of Justice report, women aged 16-24 experience the highest per capita rate of intimate violence in the United States. This means that women in college are at risk of being victims of domestic violence. Sometimes women stay in violent relationships because they: feel like they don’t deserve better, lack positive models for resolving relationship conflicts, or believe that jealousy and controlling behavior is a demonstration of “real love.” While the majority of victims of domestic violence are women, men can also be victimized and should seek assistance when needed. Despite the fact that all relationships take work, a healthy relationship should allow for both parties to feel better about self, not worse. Leaving unhealthy relationships can be difficult because with jealousy and controlling behavior often comes isolation from support. Oftentimes it may be necessary to seek advice/counseling outside the relationship to accurately assess the health of your relationship.

Eating Disorders

As our culture continues to emphasize the importance of physical appearance it is no surprise that many college students feel the pressure to conform to these oftentimes unrealistic standards. The traits of self-discipline and attention to detail that are encouraged in the successful college student can also be risk factors for the development of eating disorders. Intense fear of gaining weight, restricting food intake, failure to maintain a healthy body weight, binge eating, a sense of little control over eating, compensatory behavior in order to prevent weight gain (vomiting, misuse of laxatives, fasting or excessive exercise) are all symptoms that may be related to disordered eating. For most people the development of an eating disorder is more than just the desire to be thin. Many sufferers report low self-esteem, distorted self-image or feelings of being out of control. Depression, anxiety, anger and guilt often accompany the disordered eating and can complicate the recovery.

Examples of Eating Disorders include:

Anorexia Nervosa

A refusal to maintain body weight at or above a minimally normal weight for age and height. Intense fear of gaining weight or becoming fat. Distorted self-evaluation of own body weight or shape and a denial of the seriousness of the current low body weight. Failure to maintain at least three consecutive menstrual cycles.

Restricting Types
During the current episode, the person has not regularly engaged in binge eating or purging behavior

Binge-Eating/Purging Type
During the current episode, the person has regularly engaged in binge-eating or purging behavior.

Bulimia Nervosa

Recurrent episodes of binge eating and compensatory behavior. Binge eating is characterized by eating, in a discrete period of time, an amount of food larger than most people would eat in a similar circumstance and a lack of control over eating during the episode. Recurrent inappropriate compensatory behavior to prevent weight gain (vomiting, laxatives, diuretics, enemas, medications, fasting or excessive exercise). Binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for three months. Self-evaluation is unduly influenced by body shape and weight.

Purging Type
During the current episode, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.

Nonpurging Type
During the current episode, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting, misuse of laxatives, diuretics or enemas.

Binge Eating Disorder

Characterized by recurrent binge-eating episodes that are not followed by purging, excessive exercise or fasting. As a result many people with binge-eating disorder are overweight and experience great degrees or depression, guilt, shame and distress which often results in more binge-eating.

Grief and Loss

Grief is a deep sadness caused by loss, remorse or bereavement. There are many life events that can trigger feelings of grief and loss. Loss of relationships through break-ups, divorce, death of a family member or loved one, personal injury or significant health changes, and changes in school or employment status are all common experiences that can trigger grief. While there is no right or wrong way to grieve we have come to understand that it is normal and necessary to allow yourself time to adjust to the changes brought on by loss. Several common reactions to grief/loss have been identified and are frequently referred to as the “5 stages of grief.”

• Denial
  At first, we often deny that the loss has taken place and may act as if nothing has happened. Some mistake this as lack of caring but is often a defense against the intensity of the feelings brought on by the loss.
• Anger
  Often the grieving person is angry with the person causing the hurt, even in death or at God/the world for letting it occur. The anger is often turned inward as the grieving person may feel that there was something they should have been able to do to prevent the loss (guilt).
• Bargaining
  Ruminating about what could have been done to prevent the loss, or making “deals with God” to reverse the events that lead to the loss.
• Depression
  Loneliness, isolation, disturbed sleep and appetite, decreased energy and concentration.
• Acceptance
  Anger, sadness and symptoms of depression slowly begin to dissipate. The grieving person now comes to accept the reality of the loss.

There is no time limit for the grieving process. Good support, a healthy diet, exercise, and sufficient rest all help provide the balance necessary to navigate the process. Be patient with yourself as it is not uncommon to re-experience feelings of grief well after you thought you resolved your feelings.

Psychotic Disorders

Psychotic disorders are illnesses that affect a person’s ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. Primary symptoms include hallucinations, unusual sensory experiences or perceptions of things that are not really present, and delusions, false beliefs that do not change despite contrary evidence. At times people dealing with these symptoms have difficulty managing the activities of daily living. Other symptoms can include: disorganized or incoherent speech, confused thinking, slowed or odd movements, decreased interest in personal hygiene, decreased interest in usual activities, detached manner or inability to express emotion and paranoia.

It is not known how or why some people develop psychotic disorders but researchers believe they may run in families. Besides inheritance, research indicates that a chemical imbalance related to dopamine may be a factor in the development of psychotic disorders. Age of onset is generally between ages 18 and 30 and is often preceded by extreme stress, major life changes or drug abuse. It is not believed that these events cause psychotic symptoms but rather “open the gates” for individuals already predisposed to psychotic illness.

The key to the successful management of symptoms is early identification, diagnosis, medication management and supportive psychotherapy. It is often beneficial for family members of the affected person to get their own support as it is extremely difficult to see a loved one deal with these changes.

Relationship Issues

Throughout our life, we experience countless relationships of all shapes and sizes. Child, friend, student, sibling, mentor, co-worker, partner or roommate. The list goes on and on. Each of these relationships is unique in its structure and dynamic. As we grow and mature our relationships also change. In college, being a significant other or roommate may feel more important than being a sibling or child. Vital for all healthy relationships are honesty, direct communication and compromise. It is also important to recognize when relationships become unhealthy or negative. Below are some characteristics of both healthy and unhealthy relationships. If you feel that any of your relationships are unhealthy or not satisfying it may be beneficial to talk to someone outside the relationship for perspective.

Characteristics of Healthy Relationships

• Each person maintains individual rights and uniqueness
• Each person feels free to express thoughts and feelings
• Mutual respect and trust
• Shared decision making
• Respect for personal and sexual boundaries
• Willingness to express needs and honestly discuss conflicts
• Understanding that conflict and anger are O.K.
• Non-violent approach to conflict
• Taking responsibility for own feelings and mistakes
• Allowing each other to have outside interests and relationships

Characteristics of Unhealthy Relationships

• A climate of negativity or an increase in negative comments
• Hurtful behavior or a tolerance for bad behavior
• Using intimidation or emotional abuse
• Blaming, avoiding or burying conflict
• Using isolation and control or any physical expressions of anger

Stress Management

Practical tips & services to help you relieve stress

Stress can be defined as the body’s response to a perceived threat or demand. The body responds to a threat by increasing heart rate, breathing rate, muscle tension and blood pressure. These changes in the body are designed to give us additional energy in a crisis situation, but in response to long-term stressors, they can cause health problems and decrease our ability to cope effectively. Therefore, when you’re feeling stressed, it’s important to take time to relax and bring your body’s heart, muscles and lungs back to normal.

Techniques that can help your body relax and relieve stress include:

• Progressive relaxation, which involves systematically tensing and releasing all the muscle groups of the body. A written description of the progressive relaxation technique is available below.
• Deep breathing (also called diaphragmatic breathing). A written description is available below.
• Meditation or guided visualization, which both serve to calm the mind and take a break from stress-inducing thoughts.
• Yoga, taking a walk or other gentle exercise.

Stress Management: Progressive Muscle Relaxation

What is progressive muscle relaxation?
Progressive muscle relaxation is an effective method for treating stress and anxiety. Concentrating on relaxing your muscles makes it difficult to think about problems and events that cause stress and anxiety.

In these exercises you focus on specific muscle groups, one at a time, tensing and relaxing each group while breathing slowly and deeply. Audio tapes that teach this technique are available at many bookstores.

How do I do this exercise?
Sit in a chair with your back straight, head in line with your spine, both feet on the floor, and hands resting on your lap. Tighten each muscle group and keep it tightened for 15 to 20 seconds. Then relax slowly and notice the difference between tension and relaxation.

It is best to start at the head and work down the body or start at the feet and work up. The muscle groups to tighten and relax are:

• Forehead and scalp
• Eyes
• Nose
• Face
• Tongue
• Jaws
• Lips
• neck
• Upper arm
• Lower arm and hands
• Chest
• Stomach
• back
• Back buttocks and thighs
• Legs
• Feet

For example, you can tighten your neck muscles by pulling your chin in and shrugging your shoulders. Hold the tension for 15 to 20 seconds. Then relax slowly. Exercise all muscle groups twice a day. Each exercise session should last 12 to 15 minutes.

Stress Management: Deep Breathing

What is deep breathing?
Deep breathing is a method of relaxation that removes tension from your body. It can be done practically anywhere. It is also called diaphragmatic breathing.

How do I do this exercise?

• Sit in a comfortable chair or lie on the floor with a pillow under the small of your back.
• Breathe in slowly and deeply, pushing your stomach out as you breathe in.
• Say the word “relax” silently before you exhale.
• Exhale slowly, letting your stomach come in.

Repeat these deep breaths 10 times without interruption. You will notice a feeling of relaxation and quietness and fewer symptoms of distress.

Practice this exercise five times a day.

Suicide Prevention

According to the CDC suicide is the 11th leading cause of death. It is estimated that for every death by suicide of young adults 15-24, there are between 100-200 suicide attempts. Evidenced by these statistics it is clear that many people contemplate suicide at some point in their lifetimes. There are several key symptoms that are commonly reported by people with suicidal ideation: anxiety, panic, hopelessness, impulsivity, mood fluctuations, loss of interest in usual activities, insomnia, withdrawal from friends and family and increase in substance abuse. It is believed that people are at greater risk when they report a history of prior suicide attempts, previous psychiatric hospitalizations, physical or sexual abuse or family history of suicide attempts. There are also several protective factors that, when present, reduce the risk of suicide. Healthy stress management strategies, religious faith, frustration tolerance, absence of psychosis, quality support systems, responsibility to children or pets and positive therapeutic relationships appear to reduce risk.

IF YOU ARE SUICIDAL, SEEK PROFESSIONAL HELP

• Contact The Student Health and Wellness Center, (414)229-7429 and ask to speak to the Counselor On Call.
  – Monday-Friday 9:00 am – 4:00 pm
• After hours or on weekends contact UWM Campus Police, 911, or go to the nearest emergency room.
• If you live in the residence halls contact your Resident Assistant (RA), Security Staff, or Residential Program Staff (RPS).
• 24/7 call 988, the UW Mental Health Support 24/7 (888-531-2142) or the Milwaukee County Crisis Line (414-257-7222)

IF YOU KNOW SOMEONE WHO IS SUICIDAL

• Remain calm, listen and offer emotional support.
• Don’t be afraid to talk about it. It is a myth that asking about suicide gives people the idea or increases the risk of it happening.
• Encourage positive actions and problem-solving.
• Get assistance. Don’t feel that you need to handle it alone.

Trauma

Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, and diminishes one’s sense of self and one’s ability to feel a full range of emotions and experiences. Over the course of a lifetime many people will experience or witness a traumatic event. Traumas can consist of a single event (accident, assault or natural disaster) or can be ongoing (physical, sexual or emotional abuse). Common reactions to trauma include:

• Intense emotion and reactivity: Anxiety, pain, fear, shame, grief, horror, anger and shock.
• Numbness: Detachment from people and one’s own feelings as a self-protective measure.
• Cognitive Impairments: Difficulty concentrating, impaired memory, decreased interest in everyday activities and hopelessness.
• Flashbacks: Re-experiencing the traumatic event over and over. Not feeling in control of intrusive thoughts or memories.
• Nightmares: Re-experiencing traumatic events through dreams. Can severely impact quality of sleep and mood.
• Avoidance: Avoiding people, places and reminders of anything associated with the traumatic event.
• Physical symptoms: Headaches, fatigue, panic symptoms (palpitations, sweating, shortness of breath?), appetite changes, increased startle response and potential for increased substance abuse.

Coping

• What you are feeling is normal. Allow yourself time to adjust to new feelings.
• Reach out to friends and family who can be supportive. Spend time with others despite the instinct to withdraw.
• Talk. Talking can help reduce some of the anxious feelings and intense emotions.
• Maintain structure in your life. Keeping schedules, staying active, planning, and lists can help refocus your energy.
• Get involved. Join groups; look for ways to help others.
• Ask for help when your reactions or feelings continue to interfere with your daily functioning or social life.